Casual Sex with Pelvic Pain
If you’re someone who experiences pelvic pain, vaginismus, or vulvodynia, it probably influences how you approach sex. Often times clients come in experiencing pelvic pain, and they’re in long term, monogamous partnerships. If this is the case, I often spend time asking questions about the dynamic between my client and their partner, and how their partner can help co-create a context where pain free or less painful sex can occur. Within this kind of conversation or intervention, there’s an assumption of the possibility for ongoing communication and difficult conversations. There’s an assumption around an inherent foundation within the relationship built on trust and understanding.
Other times, folks come in, wanting be able to date and sleep around in a more casual way. When this happens, it can be helpful to think about what the expectations around treatment can look like, and how to best proceed. When someone wants to be slutty with pelvic pain, I tend to think of it in three options, that can always feed into each other:
Be open and vulnerable about what you’re experiencing; see if the person can hold the complexity of that
Don’t engage in casual sex until you are having pain-free experiences, either in the clinic or on your own
Engage in sex that does not trigger your pelvic pain
Option 1: Being vulnerable
This is a great option if you a) want to practice being open and honest without shame, for the sake of practicing those skills #badass b) if you’re with someone that you feel you can trust, even if it’s just casual or c) if you’re having sex with someone who might become a longer term connection, even if it’s still casual.
It’s hard to state our needs and to practice setting boundaries. It places you in a position where you might feel more at risk for getting hurt. BUT it can feel empowering to own your experience and try to communicate that to another person. ESPECIALLY if you’re having sex with someone who’s a decent person and who makes it clear that they care about your experience.
Once you decide whether or not this person can hold your experience, you can also discern if you want to try engaging in the kind of sex that might trigger a pain response. Having discussions around safe words and after care can also be part of this disclosure. Additionally, if you end up not being able to have the kind of sex that you want to have, how do you and this other person want to manage potential disappointment together? Can you hold disappointment while pivoting to some other kind of sexy connection? Or do you need space to process and feel your feels on your own? This can be helpful to think and talk through, especially if you’re not trying to develop too much emotional intimacy with someone!
Option 2: Don’t have casual sex until you’re pretty sure it won’t be painful
This is a great option if you’re someone who likes have feel more in control over their experience. If the thought of being vulnerable with a stranger makes your stomach turn, you’re definitely not alone. In pelvic floor physical therapy or occupational therapy, you can work on reducing your pelvic pain, as well as on your own. Tools that can be helpful are movement, dilators, breathwork, nervous system settling, sex therapy, and manual work. As you progress in your journey, you will hopefully feel more confident that you can have the kind of sex you want. Once this feels true, having casual sex might feel more accessible.
Option 3, which can definitely feed into option 1: There’s a million ways to “have sex”
It can feel hard to undo the cultural hierarchy around sex that most of us have inherited to some degree, where sex=some form of penetration. When penetrative sex is placed as the pinnacle sexual experience, and everything else is just foreplay or second tier, it may feel hard to take PIV sex off the table. I think it’s really helpful to question the assumptions we have about what sex should look or feel like. It may be helpful to go through a Yes/No/Maybe list by yourself first to start to envision what a sex life that decenters penetration could look like. This might allow you to approach your sexual encounters with a new found empowerment and understanding around what you want and how to communicate it.
I always say: having pain with sex requires creativity, which can make it more fun! But reflecting on what you want out of casual sexual encounters as someone with chronic pain can definitely help to create a sense of empowerment and safety. Try pelvic floor physical therapy or occupational therapy can definitely help you figure out what tools are right for you!
